Intercity Lines Payment Authorization Form


Please fill out the fields & sign below if paying with a credit card. 

Intercitylines.com – 800-221-3936 – Info@intercitylines.com – P.O Box 1299 Warren, MA

Credit Card Payments can be made using a Visa or MasterCard. 
We do not accept American Express or other cards. We do not accept payment from 3rd parties. 

Name on Credit Card:    

Date: 

Phone Number:   

Email:   

Year, Make, & Model of the Vehicle being Transported:   

Pick Up City & State:   

Delivery City & State:   

Cost of Transport:   

Billing Address:   

For your security, we will call you for your credit card #. We typically run Credit Card payment’s once pick up has been scheduled 2-3 days before. 

I, the cardholder, authorize Intercity Lines, Inc to charge my Visa or Mastercard for payment of the vehicle transport described above. (PLEASE DO NOT PUT ANY PUNCTUATIONS IN YOUR LEGAL NAME. IT WILL NOT ALLOW YOU TO SIGN)

Leave this empty:

Signature Certificate
Document name: Intercity Lines Payment Authorization Form
Unique Document ID: 3156e22e5db59ff9fb4437aaa47f277f84e6a4e4
TimestampAudit
October 26, 2018 11:28 am EDTIntercity Lines Payment Authorization Form Uploaded by intercity lines - deanwilson012@gmail.com IP 50.250.58.137